Development and feasibility of a telemedicine tool for patients with recurrent urinary tract infection: myRUTIcoach.

INTRODUCTION AND HYPOTHESIS: Patients with recurrent urinary tract infection (rUTI) have limited knowledge of preventive strategies to lower the risk of UTI. We aimed to develop and test the feasibility of an eHealth system for women with rUTI, named myRUTIcoach, and explored the facilitators and barriers related to its adoption. METHODS: We developed myRUTIcoach in a structured iterative process and tested its feasibility among 25 women with rUTI over 2 months. Subsequent questionnaires covered satisfaction, accessibility, and experiences with myRUTIcoach. A random selection of participants and relevant stakeholders took part in semi-structured interviews to explore adoption. Data were analyzed and elaborated using inductive and deductive approaches using the Non-adoption, Abandonment, Spread, Scale-up, and Sustainability (NASSS) framework. RESULTS: MyRUTIcoach was not only widely accepted but also facilitated communication with health care professionals (HCPs) and contributed to greater knowledge of rUTI. Women graded the system a mean of 8.0 (±0.6) out of 10, with 89% stating that they would recommend it to others. Patients indicated that self-management skills were the major facilitators and barriers related to adoption, whereas HCPs stated that the disconnect between myRUTIcoach and electronic health care records (EHRs) was the major barrier. CONCLUSIONS: This research describes the development and testing of myRUTIcoach for women with rUTI. Patients and HCPs reported high satisfaction and compliance with myRUTIcoach. However, adoption by the intended users is complex and influenced by all examined domains of the NASSS framework. We have already improved linkage to EHRs, but further optimization to meet patient needs may improve the effectiveness of this self-management tool for rUTI.

Residual malaria transmission and the role of Anopheles arabiensis and Anopheles melas in central Senegal.

Understanding the behavior and ecology of local malaria vectors is essential for the effectiveness of the commonly used vector-targeted malaria control tools in areas of low malaria transmission. This study was conducted to determine species composition, biting behavior and infectivity of the major Anopheles vectors of Plasmodium falciparum in low transmission settings in central Senegal. Adult mosquitoes were collected using human landing catches during 2 consecutive nights and Pyrethrum Spray Catches in 30-40 randomly selected rooms, from July 2017 to December 2018 in 3 villages. Anopheline mosquitoes were morphologically identified using conventional keys; their reproductive status assessed by ovary dissections, and a sub-sample of Anopheles gambiae s.l. were identified to species level using polymerase chain reaction (PCR). Plasmodium sporozoite infections were detected using real-time quantitative PCR. During this study 3684 Anopheles were collected of which 97% were An. gambiae s.l., 0.6% were Anopheles funestus, and 2.4% were Anopheles pharoensis. Molecular identification of 1,877 An. gambiae s.l. revealed a predominance of Anopheles arabiensis (68.7%), followed by Anopheles melas (28.8%), and Anopheles coluzzii (2.1%). The overall human-biting rate of An. gambiae s.l. was highest in the inland site of Keur Martin with 4.92 bites per person per night, while it was similar in the deltaic site, Diofior (0.51) and the coastal site, Mbine Coly (0.67). Parity rates were similar in An. arabiensis (45%) and An. melas (42%). Sporozoite infections were detected in both An. arabiensis and An. melas with the respective infection rates of 1.39% (N = 8) and 0.41% (N = 1). Results suggest that low residual malaria in central Senegal is transmitted by An. arabiensis and An. melas. Consequently, both vectors will need to be targeted as part of malaria elimination efforts in this area of Senegal.

[Ability of ophthalmic technicians to identify a normal ophthalmological examination]. / Capacité discriminative de la normalité de l'examen ophtalmologique par les orthoptistes.

INTRODUCTION: Ophthalmology care has been growing for several years. Since ophthalmic technicians have the opportunity to perform delegated procedures, it is important to evaluate their training. OBJECTIVE: To evaluate the ability of 3rd year ophthalmic technician students and graduates to assess the normality of an ophthalmological examination and to determine a proposed time delay for seeing an ophthalmologist. MATERIALS AND METHODS: One hundred records including ophthalmology examinations were shown to 8 ophthalmic technician students in their third year of study and to 3 graduated technicians. Three ophthalmologists determined the content of the files, the pathological nature or not of the case, as well as the proposed time for seeing an ophthalmologist. We calculated the sensitivity and specificity to recognize the normality of the case, as well as the concordance between the proposed time for seeing an ophthalmologist. RESULTS: For recognition of a normal case, the sensitivity was 80%, and the specificity was 83% in the group of technician students, and 81% versus 80% respectively in the group of graduated technicians. For the proposed time of consultation for seeing an ophthalmologist, the kappa agreement coefficient was 0.30 in the group of students and 0.41 in the group of graduates (low and moderate agreement respectively). CONCLUSION: The study showed a good ability of technicians to recognize the normality or not of clinical cases, but their ability to judge the appropriate timing of treatment by an ophthalmologist remains insufficient.

Comparison of five organic wastes regarding their behaviour during composting: part 2, nitrogen dynamic.

This paper aimed to compare household waste, separated pig solids, food waste, pig slaughterhouse sludge and green algae regarding processes ruling nitrogen dynamic during composting. For each waste, three composting simulations were performed in parallel in three similar reactors (300 L), each one under a constant aeration rate. The aeration flows applied were comprised between 100 and 1100 L/h. The initial waste and the compost were characterized through the measurements of their contents in dry matter, total carbon, Kjeldahl and total ammoniacal nitrogen, nitrite and nitrate. Kjeldahl and total ammoniacal nitrogen and nitrite and nitrate were measured in leachates and in condensates too. Ammonia and nitrous oxide emissions were monitored in continue. The cumulated emissions in ammonia and in nitrous oxide were given for each waste and at each aeration rate. The paper focused on process of ammonification and on transformations and transfer of total ammoniacal nitrogen. The parameters of nitrous oxide emissions were not investigated. The removal rate of total Kjeldahl nitrogen was shown being closely tied to the ammonification rate. Ammonification was modelled thanks to the calculation of the ratio of biodegradable carbon to organic nitrogen content of the biodegradable fraction. The wastes were shown to differ significantly regarding their ammonification ability. Nitrogen balances were calculated by subtracting nitrogen losses from nitrogen removed from material. Defaults in nitrogen balances were assumed to correspond to conversion of nitrate even nitrite into molecular nitrogen and then to the previous conversion by nitrification of total ammoniacal nitrogen. The pool of total ammoniacal nitrogen, i.e. total ammoniacal nitrogen initially contained in waste plus total ammoniacal nitrogen released by ammonification, was calculated for each experiment. Then, this pool was used as the referring amount in the calculation of the rates of accumulation, stripping and nitrification of total ammoniacal nitrogen. Separated pig solids were characterised by a high ability to accumulate total ammoniacal nitrogen. Whatever the waste, the striping rate depended mostly on the aeration rate and on the pool concentration in biofilm. The nitrification rate was observed as all the higher as the concentration in total ammoniacal nitrogen in the initial waste was low. Thus, household waste and green algae exhibited the highest nitrification rates. This result could mean that in case of low concentrations in total ammoniacal nitrogen, a nitrifying biomass was already developed and that this biomass consumed it. In contrast, in case of high concentrations, this could traduce some difficulties for nitrifying microorganisms to develop.

Comparison of five organic wastes regarding their behaviour during composting: part 1, biodegradability, stabilization kinetics and temperature rise.

This paper aims to compare household waste, separated pig solids, food waste, pig slaughterhouse sludge and green algae regarding their biodegradability, their stabilization kinetics and their temperature rise during composting. Three experiments in lab-scale pilots (300 L) were performed for each waste, each one under a constant aeration rate. The aeration rates applied were comprised between 100 and 1100 L/h. The biodegradability of waste was expressed as function of dry matter, organic matter, total carbon and chemical oxygen demand removed, on one hand, and of total oxygen consumption and carbon dioxide production on the other. These different variables were found closely correlated. Time required for stabilization of each waste was determined too. A method to calculate the duration of stabilization in case of limiting oxygen supply was proposed. Carbon and chemical oxygen demand mass balances were established and gaseous emissions as carbon dioxide and methane were given. Finally, the temperature rise was shown to be proportional to the total mass of material biodegraded during composting.

Histerectomía obstétrica en el Hospital de Puerto Montt, 2000-2005 / Obstetric hysterectomy in the Puerto Montt Hospital, 2000-2005

Se presenta la revisión de 25 pacientes con histerectomía obstétrica (HO) periparto ocurridas en el Hospital de Puerto Montt en el período 2000 - 2005. En 24 casos (96 por ciento) el parto fue por operación cesárea. El riesgo de HO periparto es 56 veces mayor en los partos cesárea que en los partos vaginales. Las principales causas de interrupción fueron cicatriz de 2 o más cesáreas en las cesáreas electivas y en las cesáreas urgentes la metrorragia del tercer trimestre. La principal causa clínica de HO es el acretismo placentario en 12 casos (48 por ciento) seguido de atonía uterina en 8 casos (32 por ciento). El estudio histológico se hizo en el 76 por ciento de los casos de los cuales el 80 por ciento confirma acretismo placentario. La HO total se realizó en 13 casos (52 por ciento) y subtotal en 12 casos (48 por ciento). El tiempo operatorio promedio fue de 124,3 + - 37,8 minutos. El hematocrito post operatorio tiene un descenso menor en las pacientes con HO subtotal que en la total (p< 0,05). La principal complicación fue la lesión vesical, que ocurrió en mayor proporción en el grupo de la HO total versus la subtotal (3:1), sin diferencias significativas. No se registró muerte materna asociadas a HO; hubo 4 muertes neonatales, 3 en relación a sufrimiento fetal agudo por metrorragia del tercer trimestre y 1 por infección ovular.

3-D coculture of hepatic sinusoidal cells with primary hepatocytes-design of an organotypical model.

Models for cocultures of parenchymal (PC) and nonparenchymal cells (NPC) of the liver relied on mixing the cells in a two-dimensional configuration or on establishing spheroidal aggregates. In vivo hepatic nonparenchymal cells, such as endothelial cells and Kupffer cells, are separated from parenchymal cells by extracellular matrix (ECM). Due to their location outside of the space of Disse they can form a barrier toward the sinusoid. Hepatocytes are attached to ECM of the space of Disse via two opposing sinusoidal surfaces. No three-dimensional coculture model reflecting this specific microenvironment of the liver cell plates in vivo has been available to date. We designed a three-dimensional model by positioning NPC on top of PC enclosed as a monolayer within a collagen sandwich. A gas-permeable membrane support can be used to allow the supply of oxygen to the resulting cell plate also from underneath the cell layers. Morphological analysis was performed by inverse and cross-sectional studies by light microscopy, scanning, and transmission electron microscopy of the coculture model. Cuboidal hepatocytes formed confluent layers below the NPC layer. They regularly expressed bile canaliculi at intercellular contact zones. Both sinusoidal surfaces expressed microprojections. Characteristic NPC including endothelial cells, Kupffer cells, and Ito cells completely covered the second matrix layer within a week. Kupffer cells were located on top of endothelial cells. Ito cells were intermingled and could be identified by their intracytoplasmic lipid droplets. LPS stimulation of cocultures resulted in a depression of albumin secretion. Phase I and phase II metabolites of the cytochrome P-450 1A1 substrate ethoxyresorufin were generated independently from the presence of cocultured NPC. This study describes the development of a novel three-dimensional coculture model, which intends to mimic more closely the microenvironment of the hepatic sinusoid by respecting the specific plate structure of the liver parenchyma. The model could serve as a complex tool to study potential collaborations between PC and NPC of the liver.

[Tricyclic antidepressants in depressed patients with cardiovascular diseases: a contraindication?]. / Trizyklische Antidepressiva bei depressiven Patienten mit kardiovaskulären Erkrankungen: Eine Kontraindikation?

Depressive disorder and cardiovascular diseases occur quite frequently together in the same patient, especially in older patients. On the one hand depressions can increase the risk of cardiovascular diseases, on the other hand cardiac disease can lead to depressive disorders in need of treatment. Thus the problem of prescribing tricyclics for patients with cardiovascular diseases is of great clinical relevance. In our review we summarize first of all the important cardiovascular effects of tricyclics in healthy persons and patients with cardiovascular diseases. Indications and (relative) contraindications for this medication with respect to cardiovascular disorders and proposals for diagnostic procedures in the beginning and during the course of antidepressant medication are following. Finally we present some recommendations for the treatment of tricyclic-induced side effects.

Antibodies to a renal Na+/glucose cotransport system localize to the apical plasma membrane domain of polar mouse embryo blastomeres.

Mouse preimplantation embryos were examined for the cell surface expression of epitopes that cross-react with antibodies to a 75-kDa subunit of a purified porcine renal brush border Na+/glucose cotransport system. A Na+ cotransport system is hypothesized to reside in the apical plasma membrane domain of mouse polar blastomeres and to be associated with the induction of their apical-basal polarity. Western blot analysis showed that unfertilized oocytes as well as preimplantation embryos contain a cross-reacting antigen with an apparent molecular weight of about 75,000. Embryos and their isolated blastomeres were double-labeled and assayed by indirect immunofluorescence (IIF) for the expression of epitopes (visualized by labeling with rabbit antiserum or mouse monoclonal IgG to cotransporter followed by the appropriate rhodamine-conjugated second antibodies) and for the development of cell surface polarity (visualized by the apical restriction of fluoresceinated succinylated concanavalin A binding; FS Con A). IIF did not detect these epitopes until after the second cleavage when 4-cell embryos expressed low-to-moderate levels. Although epitopes were expressed on all surfaces of 4-cell blastomeres, some blastomeres expressed more epitopes on their apical surfaces than on their basolateral ones. All precompaction 8-cell embryos expressed epitopes, with expression being greater apically on some blastomeres. The level of expression appeared to reach a maximum on morulae and to decline on cavitating embryos. Assays performed on isolated blastomeres from postcompaction embryos showed that by the 16-cell stage epitope expression appeared to become restricted to FS Con A-labeled apical plasma membrane domains and was no longer evident on basolateral domains. This apparent apical restriction of epitope expression was confirmed by electron microscopic examination of immunogold-labeled isolated polar 16-cell blastomeres. These results demonstrate that preimplantation mouse embryos contain an antigen(s) that is immunologically and structurally similar to a 75-kDa renal Na+/glucose cotransporter. The onset of cell surface expression of this antigen precedes development of the stable polar phenotype.

Expression of Na,K-ATPase alpha and beta subunit genes during preimplantation development of the mouse.

Na,K-ATPase is a plasma membrane enzyme that plays a critical role in eutherian blastocoel formation (cavitation) by pumping Na+ into the extracellular space enclosed by the trophectoderm. Previous experiments with the mouse had shown that the alpha (catalytic) subunit of the enzyme becomes detectable by immunocytochemistry in the late morula, just prior to the onset of cavitation. In the present study we have used cDNAs corresponding to three mRNA isoforms of the alpha subunit and a beta subunit to determine which genes are expressed during preimplantation development and to explore the timing of their expression. Of the three alpha subunit cDNAs tested by Northern blot hybridization with blastocyst RNA, only alpha 1 produced a hybridization signal, recognizing a single mRNA about 4 kb in length. This mRNA is relatively abundant in zygotes but barely detectable by the 2-cell stage and then accumulates steadily thereafter to reach its preimplantation maximum in blastocysts. The beta 1 cDNA detected mRNA of about 2.6-2.8 kb. This mRNA is present in zygotes but could not be detected in 2-, 4-, or 8-cell stages; it is present at a low level in late morulae and is abundant in blastocysts. The temporal profile of accumulation of beta 1 mRNA thus matches more closely than does alpha 1 the timing of appearance of the catalytic subunit. This suggests that the beta subunit may regulate production of the holoenzyme and hence the timing of cavitation.

Some chemical and biochemical aspects of liver microsomal metabolism of tamoxifen.

The triarylethylene antiestrogen tamoxifen (TAM) has been shown to undergo N-demethylation, 4-hydroxylation, and N-oxidation in animals and man. We have studied the effects of drug metabolism inhibitors metyrapone and SKF 525-A, and an inducer (phenobarbital), on these processes and on overall TAM metabolism, in the presence of rat and rabbit liver microsomes. In the rabbit, metyrapone had no significant inhibitory effects. In the rat, it inhibited N-demethylation by 40% at a concentration of 1 microM, while overall TAM metabolism and 4-hydroxylation were unaffected. SKF 525-A markedly inhibited all of these processes in both species. Enzymatic N-oxidation of TAM in the rat was unaffected by either inhibitor, suggesting this to be independent of cytochrome P-450. In the rat, phenobarbital pretreatment increased N-demethylation by 105% and decreased 4-hydroxylation by 48% compared to corresponding rates in untreated animals. Together with the results obtained with the inhibitors, these findings implicate participation of alternative isoenzymatic forms of cytochrome P-450 in N-demethylation and 4-hydroxylation of TAM. In the rat, the sum of the amounts of the three metabolites found was less than the amount of TAM metabolized, implying the existence of additional biotransformation routes. Radiochromatographic analysis of extracts of incubation mixtures showed the presence of the three known metabolites, plus two additional ones. The more polar of these was spectrally and chromatographically identical to authentic 4'-hydroxytamoxifen. The other one, which was slightly less polar than TAM, was tentatively identified as TAM epoxide.

Acridine araphanes: a new class of probe molecules for biological systems.

The bis-acridine ring system forms the basis for new biophysical probes of novel stereochemistry. Spectral data indicate that certain alkylene bridged bis-9-aminoacridines have a parallel plane conformation of predictable interplane distance. The parallel plane conformation is independent of solvent and thus is different from nucleic acid systems. This stable conformation allows these compounds to be used as sensitive "rulers" for describing binding site geometry in cholinergic enzymes and in the delineation of the mechanism of allosteric control in acetylcholinesterase.

Photochemical transformation of the DDT and methoxychlor degradation products, DDE and DMDE, by sunlight.

DDE and DMDE, degradation products of the pesticides DDT and methoxychlor, rapidly undergo an unusual photoisomerization in solution when exposed to sunlight. The isomerization involves the exchange of a vinyl chlorine and an ortho aromatic hydrogen. Other photoproducts identified were corresponding benzophenones and 1,1-diaryl-2-chloroethylenes. Quantum yields for the reactions were measured and then used to compute sunlight photolysis half-lives for DMDE and DDE. Although both compounds absorb only the short-wavelength ultraviolet component of sunlight, their photolysis was found to be surprisingly rapid. During summer at latitude 40 degrees N, the photolysis half-lives near the surface of a water body are one hour and one day for dissolved DMDE and DDE, respectively. Photolysis of the DDE photoisomers is about an order of magnitude slower than that of DDE, suggesting that they may accumulate under environmental conditions. The DDE photoisomers photocyclize to form chlorinated dibenzofulvene and dichlorofluorenone. Neither DDE nor its photoisomers photoreact in solution to form PCB's. The environmental significance of these results is discussed, and its is suggested that the persistence of DDE in inland surface waters may be related to its tendency to sorb onto sediments and biota where not light is present.

The ultrastructure of the interstitial cells in human fetal ovaries.

Steroid-active interstitial cells (stromal lutein cells) in human fetal ovaries of 12, 15 and 22 weeks of gestation were studied by means of electron microscope. The large cells, which are predominantly situated in the vicinity of capillaries, show high structural similarity to Leydig cells (type A) of the fetal testis. Both are characterized by extensively development of smooth endoplasmic reticulum, accumulation of lipids, and numerous mitochondria of the tubular type containing osmiophilic inclusions. Whether the interstitial cell system of the fetal ovary has any specific function in developmental physiology of the genital system cannot be decided on the basis of the present results. Its differentiation may only indicate adequate response of competent mesenchymal cells to gonadotropic stimulation.